The document discusses strategies for scaling up access to health services, emphasizing the importance of political commitments, management capacity, and innovative approaches within complex health systems. It highlights the need for effective coordination among various stakeholders, including governments, funding agencies, and local innovators, to address inequalities and improve health outcomes. Additionally, it outlines workshop objectives focused on exploring innovative practices and learning to enhance health system capacity for better service delivery to the poor.

1. Beyond Scaling Up Pathways to Universal Access to Health Services Gerald Bloom Senior Researcher, Future Health Systems Consortium Convenor of Health Domain of the STEPS Centre

2. The challenge of rapid scaling up Political commitments to increases in access, increases in funding for health systems and creation of new global organisations Path dependency and the management of change in a dynamic and complex context (emergence of complex health systems and shift from absolute scarcity to problems with safety, quality and cost) Meeting the needs of the poor in contexts of changing patterns of inequality Unexpected outcomes, unintended consequences and the need for systematic knowledge and shared understandings

3. Taking management systems to scale Financial commitments and absorption capacity Creation and rapid spread of effective arrangements in large public or private organisations Embody learning in institutions and avoid reinventing the wheel Simple-to-understand accountability arrangements Difficulties in transferring institutional arrangements between contexts (risk of failure or of unintended consequences)

4. Spreading learning from pilots The importance of political and management leadership Building management capacity and management systems Incentives and local institutions (formal and informal) Local adaptations for local contexts The importance of learning approaches

5. International Health Partnership and Public Sector Reform Strengthening coordination between funding agencies Lead role of government and defining roles of different ministries Strategies for reform and revitalisation of the public sector (islands of excellence, strengthening accountability) Can the health sector lead public sector reform (the need for a learning approach)?

6. Innovation systems for health Origination, diffusion and adaptation of innovations (technological and organisational) Producers of innovation (R&D centres, local service providers, informal entrepreneurs) Innovative organisations (local innovators, government agencies, social entrepreneurs, private companies) level of organisational innovation (micro, macro and meso) Geographical location of centres of innovation

7. Discontinuity, disruption and transition -1 Sustaining and disruptive innovations New niches for public and private providers of health-related goods and services - growth in demand for inexpensive and effective health care associated with economic growth, demographic change and spread of knowledge Spread of the informal economy, emergence of problems with cost, quality and safety and the disruption of existing institutional arrangements for service delivery and distribution of pharmaceuticals

8. Discontinuity, disruption and transition -2 Low cost information and communication technologies are creating new opportunities for spreading access to expert knowledge to providers and users of services and new regulatory challenges to prevent excessive influence by interest groups Locality and disease-specific social responses to health-related problems Construction of new types of partnership for safe, effective and affordable health services

9. Workshop objectives To explore approaches that have fostered innovation, rapid learning and large scale impact in the health sector that incorporate context and social arrangements as central to learning and change To identify practical approaches for collaboration between innovators, researchers, governments and funding agencies to strengthen the capacity of health systems to meet the needs of the poor

10. Workshop approach Background paper Six sessions beginning with short presentations of new understandings and new learning to provoke discussion Final session to summarise key lessons and next steps

11. Workshop structure Experiences from large scale health interventions Exploring local innovation Innovation in contexts of major challenges and rapid change How does the increased flow of information influence the speed and coherence of change? Citizen/health system relations Building evidence to support rapid change Key lessons and next steps

12. Recording our discussions Kate Hawkins and Peroline Ainsworth will take notes and review them with session chairs We will present a summary of key ideas and suggestions in the final session We will produce a final report in the form of short briefings on each session

13. Workshop outcomes Written outputs (articles, book, policy briefs and so forth) Opportunities for innovative interventions and potential risks Important knowledge gaps and strategies for bridging them Wider partnerships for learning and change